NBME 1 difficult Q

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NBME 1 difficult Q

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kity
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Topics: 32
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02/28/07 - 09:28 AM

29. A previously healthy 87-year-old woman comes to the physician because of a 4-month history of vulvar itching. Examination shows excoriated areas from scratching and a white, thin vulva. The labia minora are absent, and there are small fissures at the introitus. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?

A
) Escherichia coli infection

B
) Lichen sclerosus

C
) Squamous cell carcinoma

D
) Trichomoniasis

E
) Vulvar melanoma

F
) Vulvar vestibulitis

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robin082006
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02/28/07 - 10:22 AM

B

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sweetybokhari
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02/28/07 - 10:29 AM

vanshita
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03/04/07 - 09:35 AM

Can some one tell me more about
) Lichen sclerosus

NE
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03/05/07 - 02:34 PM

Lichen sclerosus is a rare condition that creates patchy, white skin that's thinner than normal;may affect body skin but most often involves skin of the vulva, foreskin of the penis or skin around the anus.
Risk factors: postmenopausal women
prepubertal children
Symptoms- itching, pain, easy bruising, smooth white spots in the involved area
Persistent lichen sclerosus in one location increases risk of squamos cell carcinoma.
Treat: Ultraviolet light treatment, for nongenital areas
Immune-modulating medications (topical steroids)
Estrogens ( topical)

http://images.google.com/imgres?imgurl=http://www...

dr in trouble
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03/08/07 - 10:37 PM

Its B.

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vanshita
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03/10/07 - 10:41 AM

thanks NE for nice explanation

Justice
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03/29/07 - 12:24 PM

(B)

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shadia
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04/13/07 - 09:01 AM

Ivonne
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01/25/08 - 08:15 PM

#10

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drshvetasm
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01/26/08 - 10:54 AM

#11

B

how does E...vulvar vestibulitis present? same old redness,itching, dyspareunia...and probably a younger patient?? anything characteristic? any char histopath?

Ivonne
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01/27/08 - 08:57 AM

#12

drshvetasm wrote:
B

how does E...vulvar vestibulitis present? same old redness,itching, dyspareunia...and probably a younger patient?? anything characteristic? any char histopath?

Vulvar vestibulitis

This condition is characterized by severe burning and pain with vestibular touch or attempted vaginal entry. Typically, it follows a chronic course and may show variable numbers of minute spots of vestibular erythema, ranging in diameter from 2-7 mm. Rarely, small ulcerations are detectable.
The pain is enough to make intercourse uncomfortable or completely impossible. Associated deep pain from secondary vaginismus may occur. Understandably, varying degrees of sexual dysfunction may cause depression and anxiety.

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